The cost of prison suicideResearch briefing

• Theimpactofasuicideinprisonisprofound forthefamily,forprisoners,forprisonstaff andforallthosewhoknewtheindividualwho died.Theemotionalcostsincludepain,grief andlostqualityoflife

• Theaveragecostofasuicideinprison isnotknownbutislikelytobesubstantially higherthantheaveragecostofasuicidein thegeneralpopulation

• Therewere95suicidesinprisoninthe12 monthstoSeptember2015.Itisestimated thatthecostofthesesuicidesisatleast £160mandcouldbeashighas£300m

• Theaveragecostofasuicideinthegeneral populationhasbeenestimatedas£1.67m percompletedsuicide

• Thefinancialimpactofprisonsuicide issubstantialandwillincludestaffingcosts

• Aprisonsuicideimpactsonthefinancial resourcesofotherservicesincludingthe police,localauthoritiesandtheNational HealthService

• Investinginsuicidepreventionhasbeen showntoreducedeathsandbringabout substantialcostsavingsinthelongterm.

Key points

Introduction “Theimpactofdeathsincustodyonthefamilyandfriendsofprisonersandstaffintheestablishmentsinvolvedcannotbeover-estimated.”

HerMajesty’sInspectorateofprisons(2015)

95peopletooktheirownlivesinprisoninthe12monthstoSeptember2015.Thisincluded13youngadultsaged18–24andfourwomen.Theimpactofaself-inflicteddeathincustodyisprofoundforthefamily,forprisoners,forprisonstaffandforallthosewhoknewtheindividualwhodied.Thehumancostsofanyself-inflicteddeathareintangibleyetfar-reaching.Thisisevenmoretrueofadeathincustody.Thecostsincludepain,griefandsufferingandlostqualityoflife.

TheHowardLeagueandtheCentreforMentalHealthareworkingtogethertoinvestigatesuicidepreventioninprisons.Theworkwillexplorehowpolice,thejudiciary,prisonsandhealthcareproviderscanworktogethertopreventpeopletakingtheirownlivesinprison.Itwillalsolookatwhatlessonscanbelearntfromthewidercommunity.Thisisthefirstinaseriesofbriefings.Whilstacknowledgingtheprimacyofemotionalcostsandtraumawhenconsideringadeath,thisbriefingshall–forthereasonsoutlinedbelow–focusonexploringthemonetarycostsassociatedwithdeathsincustody.

1. Suicides in prison FigurespublishedbytheMinistryofJustice(2015)showthatinthe12monthstoSeptember2015,95peopletooktheirownlivesbyapparentsuicideinprison.Intheprevious12months(2013–2014)therewere91apparentsuicidesinprison.

TheWorldHealthOrganisationandInternationalAssociationforSuicidePreventionrecognisethatprisonersareahighriskgroupforsuicide(WHO,2007).Prisonershaveanumberofriskfactorsforsuicidalbehaviourwhentheyenterprisonandthesuicideattemptrateishigher,evenafterreleasefromprison.Remandprisonershaveasuicideattemptrate7.5timeshigherthanthegeneralpopulationandforsentencedprisonerstherateis6timeshigher.

Arrivalinprisonisaparticularlyhighrisktime(HMIP,2015).Afifthofprisonerswhotaketheirownlivesinprisondosowithinsevendaysofreception.39percentdiewithinamonthofarrival.

Thisincludesprisonerswhohavemovedtoanewprisonduringtheirtimeincustodyaswellasthosewhohaveenteredprisonviathecourts.

Itisnotknownhowmanyself-inflicteddeathsarepreventedeachyearinprisonbytheactionsofstafforotherprisoners.Therearearound2,000prisonersatanyonetimebeingmonitoredunderPrisonServicesuicideandself-harmprocedures,knownasACCT(Assessment,CareinCustodyandTeamwork)andoutlinedinPrisonServiceInstruction64/2011:Managementofprisonersatriskofharmtoself,toothersandfromothers(SaferCustody)(MinistryofJustice,2013).

Itcannotbeassumedthatallself-harmincidentsareanindicationofattemptedsuicide,thoughsomemaybe.Inthe12monthstoJune2015therewere28,881reportedincidentsofself-harm,upby4,929incidents(21%)fromthesameperiodin2014(MinistryofJustice2015).Hawtonetal(2014)foundthatself-harminprisonswasassociatedwithsubsequentsuicideandsuggestedthatthepreventionandtreatmentofself-harmwasanessentialcomponentofsuicideprevention.

2. Why look at the cost of suicide?‘Theeconomicimpactsofsuicideareprofound,althoughcomparativelyfewstudieshavesoughttoquantifythesecosts.’

McDaidetal(2014)

Publichealthresearchershavebeguntofocusontheeconomiccostsofadeath,forexamplefromsmokingorheartdisease,inordertohighlighttheeconomicbenefitsofinvestinginpreventionandhealthpromotionandtoshowhowinvestmentinoneareacangeneratesavingsinanother.

TheDepartmentofHealthcommissionedresearch,publishedbyKnappetal(2011),ontheeconomicbenefitsofmentalhealthpreventionandpromotion.

Health systems aim to improve health and health-related well-being, but are always constrained by the resources available to them. They also need to be aware of the resources available in adjacent systems which can have such an impact on health, such as housing, employment and education. Careful choices therefore have to be made about how to utilise what is available. One immediate corollary is to ask whether investment in the prevention of mental health needs and the promotion of mental wellbeing might represent a good use of available resources.

KnappMetal(2011)estimatedthattheaveragecostpercompletedsuicideforthoseofworkingageonlyinEnglandwas£1.67m(at2009prices).Thisincludesintangiblecosts(lossoflifetotheindividualandthepainandsufferingofrelatives),aswellaslostoutput(bothwagedandunwaged),policetimeandfunerals.

TheNewZealandMinistryofHealth(2005)commissionedresearchonthecostofsuicideandattemptedsuicideasitwasconcernedaboutthehighratesofsuicideinNewZealand.Itarguedthatestimatingthecostofsuicidewasausefulexerciseasitindicatedwheresuicidepreventioninterventionsmightbefocusedtogivegreatestpotentialgain.ThestudyestimatedthattheaveragecostofservicesusedpersuicidewasNZ$10,200(around£4,000at2005prices)andNZ$3,750(around£1,468at2005prices)perattemptedsuicide.Theannualeconomiccostofsuicideandattemptedsuicidefortheyear2002wasNZ$206.2m.

AsimilarstudyontheeconomiccostofsuicideinIreland(Kennelly,2007)foundthatthecostsamountedtoaround€900millionayear(2001prices),equivalenttoaround1percentofannualGDPinIreland.TheScottishExecutive(2006)foundthatthecostofsuicideinScotlandwasjustover£1billionin2004.Thestudyestimatedthataonepercentreductioninsuicideswouldavoidcostsofupto£10.7moverthelifetimeofanindividual.

Itappearsnoonehaslookedatthefinancialimplicationsofprisonsuicidetothestate.

3. The benefits of investment in suicide prevention TheDepartmentofHealthcommissionedresearchaspartofaprojecttolookattheeconomiccaseformentalhealthpromotionandprevention.EconomistsfromtheLSE,King’sCollegeLondonInstituteofPsychiatryandtheCentreforMentalHealthconductedadetailedanalysisofcostsandbenefitsfor15differentinterventions,includingGPsuicidepreventiontraining.

Case study 1: Cost effectiveness of GP suicide prevention educationKnappetal(2011)lookedattheeconomiccostover10yearsofinvestinginGPsuicidepreventioneducation.ThestudyfoundthatthecostofsuicidepreventiontrainingforGPs,basedontheAppliedSuicideInterventionSkillsTraining(ASIST)course,was£200whichwouldmeanatotalcostofaround£8mifdeliveredtoallGPsin

England.Thereportestimatedthatnetsavingsof£1.27bnwouldariseover10yearsifintangiblecostsofsuicidewerealsoincluded.ItconcludedthatinvestmentinGPsuicidepreventiontrainingwashighlycosteffectivefromahealthsystemperspective.

ThefinancialcostofsuicidewasreferredtoinNohealthwithoutmentalhealth(DoH,2011),astrategytoimproveoutcomesforpeoplewithmentalhealthproblems.TheDepartmentofHealthstrategyrecognisedthatinvestmentinsuicidepreventionwouldleadtoconsiderablesavingsfortheNHSinthelongerterm:

Economic modelling work has estimated that suicide-training courses provided to all GPs in England could result in net savings of over £500 million after one year and further considerable savings over the longer term.

NetworkRail,theauthorityresponsiblefortherailnetworkintheUK,hasrecentlycommissionedresearchbyRSSB(2014)onimprovingsuicidepreventionmeasuresontherailnetworkinGreatBritain.

Case study 2: Costs of suicides borne by the rail industryAround4.5%ofsuicidesintheUKtakeplaceontherailway,buttheemotional,humanandfinancialcostswereseenasdisproportionatelyhighastheytookplaceinviewofpassengers,stationstaffanddriversandresultedinconsiderabledisruptiontorailservices.Around400,000minutesofdelayswereattributedtosuicidesontherailwaysin2013–2014.Analysisofthecostsofsuicidebornebytherailindustrywasestimatedtobebetween£20mand£40mperyear;thelargestelementbeingthedelayandcancellationcostspaidbyNetworkRailtotheaffectedtrainoperatingcompanies.

NetworkRailinvested£5minasuicidepreventionprogramme,inpartnershipwiththeSamaritans,whichincludedtrainingforstationstafftorecognisethoseatriskofsuicideandprovidehelpandsupporttopreventadeathontherailway.Thepartnershiphasrecentlybeenextendedforanother5years.(NetworkRail,2014)

4. The cost of prison suicide Therehasbeennopublishedresearchontheeconomiccostsofprisonsuicide.Thecostsresultingfromasuicideinprisonarelikelytobesubstantiallyhigherthantheaveragecostofsuicideduetotheimpactadeathhasonthe

prisonserviceaswellaswidersociety.Ifcostsforthe95suicidesinprisoninthe12monthstoSeptember2015wereequivalenttothecostsofasuicideinthecommunitythiswouldamounttoaround£150m.Aswegoontoelaboratebelow,however,additionalcostsassociatedwithdeathsincustodywilllikelysubstantiallyraisethesecosts.Takingtheseintoaccount,thecostscouldbeanywherebetween£160mand£300m.

Whetherasuicideoccursinprisonorinthecommunity,costswillincludethepoliceinvestigation,costofinquestsandfuneralexpenses.However,whenapersondieswhilstinthecareofthestate,therewillbeadditionalcosts.ThePrisonandProbationOmbudsmanhasastatutorydutytoconductaninvestigationintodeathsinprisoncustody.Thecoronerhasalegaldutytoinvestigateandinquestcostsarelikelytobesubstantiallyhigherduetothecomplexitiesoftheinvestigationandlegalcostsduringtheinquest.

Thefinancialcostofasuicidetotheprisonserviceissubstantialandwillincludestaffingcostsforinvestigationsandtocoverstaffsicknessabsenceduetotheimpactofasuicide.Anincreasedworkloadandstaffabsenceswillhaveaknock-oneffectonthewiderregimeinaprison,resultinginfurthercosts.

i) The financial impact on prisons Adeathincustodywillhaveaneconomicimpactonprisonbudgets.Staffhavetocomplywithstatutorydutiesfollowingthedeathofaprisonerandthiswillimpactontheirworkingday.Resourceswillalsoberequiredtoprovideadditionalcounsellingandsupportforstaffandprisonersaffectedbythedeath.

PSI64/2011Management of prisoners at risk of harm to self, to others and from others (Safer Custody)outlinestheproceduresthatmustbeadheredtofollowingadeathincustody:

Staff must co-operate fully with all investigations following a death, including those by the police, the Prisons and Probation Ombudsman (PPO), the Health and Safety Executive (HSE) where applicable and the coroner’s inquest.

Prisonstaffareresponsiblefor:reportingthedeathtothepolice;notifyingthenextofkin,thecoronerandNOMS;collatingevidence,suchasCCTVfootageanddocumentsforpoliceandPPOinvestigations;andensuringthatprisonersandotherstaffaffectedbythedeathare

supported.Prisongovernorshaveresponsibilityforwritingtothefamilyandprovidingsupporttootherprisonersandprisonstaffwhomayhavebeenaffectedbythedeath.

PSI64/2011statesthat‘prisons must offer to pay a contribution towards reasonable funeral expenses of up to £3,000’,exceptifthefamilyhasapre-paidfuneralplanorisreceivingfundingfromanothergovernmentdepartment.

TheHowardLeague(2015)revealedthatthenumberofprisonofficersinpublicsectorprisonshasbeencutby30percentinthreeyears.Adeathincustodyislikelytoimpactonstaffinglevelsthroughouttheprisonaswingstaffmayberequiredtocovercolleagueswhilsttheyattendbriefings,collaterecords,prepareforinvestigationsandattendinterviewsorinquests.

When someone dies they just become the trigger for a process and lots of paperwork for me. You’ve just got to get on with it, get the job done.(SaferCustodyStaff)

RANDEuropeandPrisonsResearchCentre,UniversityofCambridge(2015)

ResearchcommissionedbytheHarrisReviewofself-inflicteddeathsincustodyamongst18–24yearolds(2015)andconductedbyRANDEuropeandthePrisonsResearchCentreattheUniversityofCambridge(2015)foundthat‘Beinginvolvedwithadeathincustodyhassignificantimpactsupontheemotionsandpracticesofprisonstaff’.

Studiesontheimpactofsuicideonfrontlinestaffhaveshownitcanleadtoincreasedratesofsicknessandabsenteeism,undermineaprofessional’sfunctioningandcontributetoburnout(Gaffneyetal,2009andGutinetal,2010).Whenaprisonerdiesbysuicideitislikelytoimpactonstaffstressandsicknesslevelsintheimmediateaftermathandalsointhelongertermasstaffarerequiredtogiveevidenceatinquestswhichcantakeplaceayearormoreafterthedeath.

In2013–2014theaveragenumberofdayslostduetostaffsicknesswas10.8peremployee.Ratesofstressrelatedillnessandlongtermillnesshadincreasedinthesameperiod(PrisonServicePayReviewBody,2015).Thestressofdealingwithhighratesofsuicideandself-injurywasundoubtedlyafactor.

Staffabsenceswillimpactonaprison’sfinancialresourcesasotherstaffwillhavetocovertheirdutiesorusedetacheddutystafffromotherprisons.TheestimatedcostofsicknessabsenceinthepublicsectorPrisonServicein2007–2008was£78m.Thisfigurewasthecostofdayslostanddidnotincludeadditionalcostssuchasstaffcover(Hansard,2008).

ii) Police investigationThePoliceinvestigatealldeathsinprisononbehalfofthecoronerandalsotodeterminewhetheracriminalinvestigationisnecessary.Initially,thepoliceapproachalldeathsasapotentialhomicideandofficerswillbedeployedtocollectevidencefromthesceneofeachdeathandensurethatphotographsorvideosofthescenearetaken.ThisinformationwillbesharedwiththePPOatalaterdateonceithasbeenestablishedthatacriminalinvestigationisnotrequired.

Thepolicewereunabletoprovideafigureforthecostofaninvestigationintoadeathincustodyandthereisnopublisheddataontheaveragelengthoftimespentonsuddendeathinvestigations.ThestudybytheNewZealandMinistryofHealth(2005)estimatedtheaveragepolicetimewas17.9hoursattendancepersuddendeath.Thehourlyon-costsforapolicesergeantinEnglandandWalesare£36.51(Hansard,2015).Policeon-costsforinvestigationsintothe95deathsthatoccurredinthe12monthspriortoSeptember2015couldrangefrom£3,500to£62,000orhigher,dependingonthenumberofpolicehoursspentoneachinvestigation.

ItisestimatedthatBritishTransportPolicespendbetween£4.5mand£11mannuallyinrespondingtosuicidesontherailways(RSSB,2014).Thisamountstobetween£22,500and£55,000persuicide.Ifsimilarcostsareattributedtorespondingtosuicidesinprisons,theannualpolicecostscouldbebetween£2mand£5m.

iii) Prison and Probation Ombudsman’s (PPO) investigationsThePPOconductsafatalincidentinvestigationintoalldeathsthatoccurinprisonsandyoungoffenderinstitutions.Thisincludesinvestigationsintonaturaldeathsaswellasself-inflicteddeathsandhomicides.DatafromthePPOshowedthattheaveragecostofafatalincidentinvestigationintoadeathincustodyin2014–15was£10,350.

Thisfigureisanaveragecostandincludesdeathsbynaturalcausesaswellasself-inflicteddeaths.ThecostofafatalincidentinvestigationcanvarywidelyanditislikelythatthecostofaPPOinvestigationintoaself-inflicteddeathwillbegreaterthananinvestigationintoadeathbynaturalcauses.

Investigationsintoself-inflicteddeathsandhomicidesinprisonwillalmostalwaysbemorecomplexandtakelongertocomplete.Theaveragetimetakentocompleteadraftreportintoaself-inflicteddeathwas25weeks,comparedto18weeksforadeathbynaturalcauses(PPO,2015).ItislikelythatPPOinvestigatorswillcompletemoreinterviewsduringaninvestigationintoaself-inflicteddeathinordertodeterminewhathappened.

Duetothenatureofthedeath,thesensitivityrequiredandthecomplexitiesoftheinvestigation,fatalincidentinvestigationsintoself-inflicteddeathsareconductedbyseniorstaffatahigherpaygrade.During2014/15thePPO(ibid)began76investigationsintoself-inflicteddeathsacrossprisons,approvedpremisesandimmigrationremovalcentres.

iv) Coroners’ costsTheseniorcoronerhasalegaldutyundertheCoronersandJusticeAct2009toinvestigateadeathincustody.Thereisnolongeramandatoryrequirementtoholdajuryinquestforadeathinprisoncustodybutthemajorityofinquestsintodeathsinprisoncontinuetobejuryinquests.TheChiefCoroner(2015)reportedtherewere397juryinquestsin2014-2015.

Localauthoritiesappointandfundthecoronerandmeetthecoroner’scostsincludinginquestscosts,mortuarystorageandpathology.Thepolice,inmostareas,provideCoroner’sofficerstosupporttheCoronerinallaspectsoftheirstatutoryresponsibilitiessuchasmanagingtheinvestigationandliaisingwithbereavedpeople.

TheOfficeoftheChiefCoronerdoesnotholddataonthecostofinquestsandthereislimitedcomparativefinancialinformationavailablefortheCoroner’sserviceineachlocalauthority.Theaveragenetexpenditureforreporteddeathsin2006-2007wasaround£300perinquest.Localauthoritieswithahighnumberoflongandcomplexinquests,whichincludedCornwall,hadhighercostsofaround£500perinquest(CornwallCountyCouncil,2008).

Coroner’scostsforaninquestintothedeathofapersoninprisonvarywidelyandarelikelytobehigherthantheaveragecostsforareporteddeathduetothecomplexitiesofthecase.Costswilldependonthelengthoftimetakentocompletetheinquest,thenumberofpre-inquestreviewmeetingsandwhethertheinquesttakesplacewithorwithoutajury.Juryclaimsforlossofearningsandtravelexpenseswillvary.Expertwitnessesareentitledtoclaimfeesforpreparatoryworkandattendanceatinquestsandthisagainwillvarydependingonthenumberofwitnessescalledtogiveevidence.

Localauthoritieswhichhaveahighnumberofself-inflicteddeathsincustodyarelikelytoincurhighercoroner’scostsasinquestswilltakelongerandbemorecomplex.

Case study 3: Kent County CouncilKentCountyCouncilhasfinancialresponsibilityforfourcoroners’offices;CentralandSouthEastKent,MidKentandMedway,NorthEastKentandNorthWestKent.TheLGA(2015)statedthattheestimatednetexpenditureforcoroners’courtservicesinKentin2013–2014was£2,911,000comparedtoanaveragenetexpenditureof£1,085,000forallEnglishcountylocalauthorities.

TherearesevenprisonsinKent.Between2012and2014therewere14suspectedself-inflicteddeathsincustodyinKent.Emleyprisonhadseenanincreaseinthenumberofsuicidesfromthreein2012tofivein2014,oneofthehighestnumberofself-inflicteddeathsinasingleprisonthatyear.

TheKentandMedwaysuicidepreventionstrategy2015–2020recognisedthattherehadbeenanincreasenationallyandlocallyinthenumberofprisonerstakingtheirownlives.Thelocalsuicidepreventionstrategyincludedactionstoaddressthisissue.NoprisonersdiedbysuicideinEmleyprisonin2015.

2012 2013 2014 total

CookhamWood 1 0 0 1

EastSuttonPark 0 0 0 0

Elmley 3 2 5 10

Maidstone 0 1 0 1

Rochester 0 0 0 0

StamfordHill 0 0 0 0

Swaleside 2 0 0 2

Total 6 3 5 14

v) The cost of legal representation at inquestsTheNationalOffenderManagementServiceprovideslegalrepresentationthroughtheTreasurySolicitor’sOfficeforallprisonstaffrequiredtogiveevidenceataninquest.

TheMinistryofJustice(MOJ)doesnotholddetailsoftheannualcosttothewholeofGovernmentoflegalrepresentationatinquests.EachDepartmentmakestheirownarrangements.Inresponsetoaparliamentaryquestionon4July2013theMinisterforprisonsstated:

The MOJ specifically incurs legal costs at inquests following the deaths of serving prisoners. The Treasury Solicitor’s Department charges the MOJ for legal advice and representation at inquests. These charges came to £2.7 million in 2009-10; £2.1 million in 2010-11 and £2.1 million in 2011-12. The figures for 2012-13 are not yet published. It is not possible to attribute these charges to completed inquests.

Theprisonsministeralsostateditwasnotpossibletoidentifyseparatelytheamountspentonlegalaidforfamiliesofthedeceasedatinquests(Hansard,2013).

FollowingtheLegalAid,SentencingandPunishmentofOffendersAct2012(LASPO),legalaidisavailableforadviceandassistanceintherun-uptoaninquestinvolvingamemberoftheindividual’sfamily,butlegalaidforrepresentationataninquestisonlyavailablethroughthe‘exceptionalfunding’criteriaoftheAct.

TheinequalityintermsoflegalrepresentationhasbeencriticisedbyINQUESTwhichnotedthatitwasnotawareofasingleinquestintoadeathincustodywherethestatehadnotbeenlegallyrepresentedandthatthishadledtoaninequalityofarmsbetweenfamiliesandthestate(HouseofCommons,2014).Lawyersrepresentingthestatearefundedbythetaxpayeryetbereavedfamilieswhoarenotgrantedexceptionalfundinghavetocoverthecostsoflegalrepresentations,whichcanbethousandsofpounds.

5. Investing in suicide prevention TheprisonsministerAndrewSelousstated,

All prisons are required to have procedures in place to identify, manage and support people who are at risk of harm to themselves, and the National Offender Management Service (NOMS) has put in place additional resources to undertake this safer custody work.

Hansard,WA12986,22October2015

Allstaffwhoworkwithprisonersshouldreceivebasictraininginsafercustody,accordingtoPSI64/2011.TheNationalOffenderManagementServiceiscurrentlyconductingareviewoftheACCTprocesstoassessandmonitorthoseatriskofsuicideandself-harmincustody.Samaritanshasa£451,000contractwiththeMinistryofJusticetotrainListenersinprisonstoofferconfidentialpeersupporttovulnerableprisoners.PrisonerscanalsoaccesstheSamaritanshelplinefreeofcharge.

TheSecretaryofStateforJusticecommissionedtheHarrisReview(2015)toconductanindependentinquiryintotheself-inflicteddeathsincustodyof18–24yearoldsandtomakerecommendationstoreducetheriskoffutureself-inflicteddeathsincustody.

Despite additional resources and a focus on reducing self-inflicted deaths in custody, the number of self-inflicted deaths has continued to rise. Her Majesty’s Inspectorate of Prisons (2015) stated “It was [-] a matter of the greatest concern that the high number of self-inflicted deaths and incidence of self-harm among adult male prisoners persisted in this year’s findings, and many of our previous concerns about the care of those at risk continued to be repeated”.

Factors,suchasstaffingcutsandovercrowdingarehavinganegativeeffectonsuicidepreventionmeasures,includingstafftraining.TheIMBannualreportonLewesprison(2015)foundthattheSaferCustodyteamhadbeenhitbystaffingcutsandover2,000designatedhoursofsafercustodyworkhadbeenlost:

Training in ACCT (Assessment, Care in Custody, Teamwork) management is not able to take place. The ACCT document is opened on any prisoner deemed to be at risk of self-harm. There are a number of new Band 4 Supervising Officers running the wings, and they become the Case Managers for prisoners on open ACCTs. There is no one in the prison who can train them to do this. The national case management training courses have been stopped, as has the training for the trainers themselves. This has left HMP Lewes in a situation where the Case Managers must remain untrained, yet they are responsible for the documents which are designed to keep prisoners safe. The IMB finds this completely unacceptable.

HerMajesty’sInspectorateofPrisons(2015)foundthatonly58percentofstaffatAylesburyprisonhadcompletedsuicidepreventiontraining,

despiteapreviousHMIPrecommendationin2013thatallstaffshouldreceivearefreshercourseinsafercustodytraining.

63percentoftheprisonsinspectedbyHMIP(2014)in2014–2015wereovercrowdedandstaffshortageswereaffectingdaytodaylivingarrangementsinmany.Only14percentofprisonerswereunlockedfor10hourseachdayandtheinspectoratereportedthat“timeoutofcellandactivityforprisonershadreducedfurthersincelastyear’salreadypoorpicture”.

Protectivefactorswhichmightreducetheriskofsuicide,includingfamilycontact,meaningfulemployment,accesstoleisureactivitiesandhobbies,exerciseandtimeoutofdoorsarealldifficultorimpossibletoaccessinprison.ChangestotheIncentivesandEarnedPrivilegesschemeintroducedinNovember2013haveplacedfurtherrestrictionsonprisoners’accesstocopingmechanisms,particularlyforthoseonbasicorentrylevel.

Thereneedstobeaholisticapproachtoimprovingthementalwell-beingofallprisoners,notjustthoseidentifiedasatrisk.Inaddition,theremustbeareductionintheprisonpopulation,whichcurrentlystandsat85,884.Toomanypeoplearebeingremandedorsentencedtocustodywhentheydonotneedtobethere.

ResearchbytheHowardLeagueshowedthatovertwothirdsofthemen,womenandchildrenremandedtocustodyin2013wereeitheracquittedordidnotreceiveacustodialsentence.Thefiguresshowthereiswidespreadoveruseandmisuseofremand,despitethefactthattheCoalitionGovernmentpassedtheLegalAid,SentencingandPunishmentofOffendersAct(2012)toendtheuseofremandwhentherewasnorealprospectofthedefendantbeingimprisonedifconvicted.Thoseonremandaredisproportionatelylikelytotaketheirownlivesincustody.36percentofthosewhodiedduetosuicidein2014wereonremandatthetimeoftheirdeaths,despiteonly15percentoftheprisonpopulationbeingonremandatanyonetime.

Prisonisnotbeingusedasalastresort.Ofthe90,333personssentencedtoimmediatecustodybythecourtsbetweenMarch2014andMarch2015,athird(29,310)hadbeenconvictedoftheftoffences.Fourofthe60peoplewhohavetakentheirownlivesinprisonthisyearhadbeenremandedorsentencedfortheftorshopliftingLiaisonanddiversionservices,whichrefer

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peoplewhocomeintocontactwiththecriminaljusticesystemwithmentalhealthneeds,learningdifficultiesorsubstancemisuseorothervulnerabilitiestoappropriatetreatmentandsupport,hasledtoshorttermcostsavingsinthecriminaljusticesystem(CentreforMentalHealth,2015).

InJanuary2014theDepartmentofHealthannouncedaninvestmentof£25millionforliaisonanddiversionservicesandarolloutoftheservicetocover50percentofthepopulationby2015/16andthewholepopulationby2017/18.

6. ConclusionsJustaspublichealthresearchershaveconsideredthecostofsuicideinsociety,itwouldbehelpfulforpolicymakersandsentencerstounderstandthefinancialcostsofprisonsuicide.

Therearemajorgapsinattemptingtoprovideanestimateofthecostofadeathincustodyinpartduetothelackofavailabledataandthedisjuncturebetweendifferentgovernmentdepartmentsinvolvedfollowingadeathincustody.

AthematicreviewconductedbythethenChiefInspectorofPrisonsin1999notedthatsuicidewas‘everyone’sconcern’andthatisstillthecasetoday.Yetissuessuchasmentalhealthandsuicidepreventioninprisonsareoftennotconsideredinaholisticway.

TheHowardLeaguerecommendsthattheMinistryofJusticecommissionresearchtoidentifytheaveragecostsofasuicidebehindbars.Theimpactofprisonsuicideonstaffissubstantialandwillincludeemotionalandfinancialcosts.

LimitedestimatesobtainedbytheHowardLeaguesuggestthatcostscouldbefargreaterthantheaveragecostofasuicide

inthecommunity,asestimatedbyresearchcommissionedbytheDepartmentofHealth.

TheeconomicimpactofsuicideisnotjustbornebytheMinistryofJusticeandwecannotlookattheimpactofprisonsuicideinisolation.Itimpactsontheresourcesoflocalauthorities,thepoliceandhealthservices.

Theeconomicbenefitsofholisticinvestmentinsuicidepreventionandthepromotionofmentalwellbeingwillproducelongtermcostsavings,notjustfortheprisonservicebutforothergovernmentdepartments.

Afulllistofreferencesisavailableonourwebsiteathttp://www.howardleague.org/publications-prisons/

About the Howard League for Penal ReformTheHowardLeagueisanationalcharityworkingforlesscrime,safercommunitiesandfewerpeople inprison.

Wecampaign,researchandtakelegalactiononawiderangeofissues.Weworkwithparliament,themedia,criminaljusticeprofessionals,studentsandmembersofthepublic,influencingdebateandforcingthroughmeaningfulchange.

About the Centre for Mental HealthCentreforMentalHealthisanindependentnationalmentalhealthcharity.Weaimtoinspirehope,opportunityandafairchanceinlifeforpeopleofallageslivingwithoratriskofmentalillhealth.

Weidentifyeffectivemethodsofsupportinganddivertingpeoplewithmentalhealthproblemsinthecriminaljusticesystem.

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2016